A new study finds that the majority of women who have both breasts removed after a breast cancer diagnosis had a very low risk of developing cancer in their healthy breast, raising the question of whether there is the potential for overtreatment in these types of patients.

Many women who are diagnosed with breast cancer decide to have both
of their breasts removed, a procedure known as double mastectomy (or contralateral
prophylactic mastectomy). Now a
new study, published in JAMA Surgery,
finds that although fear about recurrence was a factor affecting their
decision, 70 percent of those women who had both breasts removed had a
very low risk of developing cancer in their healthy breasts.

The
researchers from the University of Michigan Comprehensive Cancer Center
studied 1,447 women who had been treated for breast cancer and who had
not had a recurrence. The study found that 8 percent of women had a
double mastectomy, and that 18 percent considered having one.

According
to the American Cancer Society, 235,030 Americans will be diagnosed
with breast cancer this year, and 40,430 will die from the disease.

Fears of Cancer Recurrence Affecting Decisions

According
to recent studies, women with breast cancer have been increasingly
choosing to have this aggressive surgery because they are worried about recurrence. About three-quarters of patients reported being very worried about
their cancer recurring.

But a diagnosis of cancer in one breast does
not increase the likelihood of cancer recurring in the other breast for
most women, according to the researchers.

Lead study author Sarah
Hawley, Ph.D., associate professor of internal medicine at the
University of Michigan Medical School, said in a press statement that
women appear to be using worry over cancer recurrence to choose
contralateral prophylactic mastectomy, “This does not make sense,
because having a non-affected breast removed will not reduce the risk of
recurrence in the affected breast,” said Hawley.

Dr. Elisa Port,
chief of breast surgery and director of the Dubin Breast Center at The
Mount Sinai Hospital in New York, told Healthline, "When women have
breast cancer in one side, they do tend to overestimate their risk of
getting a new cancer on the other side. It is our job, as surgeons, to
provide accurate information regarding these risks so women can make
decisions based on knowledge, and not driven by fear. Importantly,
breast cancer can come back or recur after someone’s been treated and
cured. But usually it does not come back in the other breast. For women
with breast cancer, the decision whether or not to remove the other
healthy breast has to be done on an individual basis, and should be a
decision made by the individual woman with guidance from her surgeon.”

The
study also found that women with higher education levels and women who
had undergone an MRI test before surgery were more likely to choose
double mastectomy. Concern about recurrence was one of the biggest
factors driving the decision to have this surgery.

Family History, Genetic Test for Gene Mutations

The
researchers asked study participants about the type of treatment they
had, as well as the clinical indications for double mastectomy,
including the patients’ family history of breast and ovarian cancer, and
the results of any genetic testing.

Women with a family history
of breast or ovarian cancer, or with a positive genetic test for
mutations in the BRCA1 or BRCA2 genes, may be advised to consider having
both breasts removed, because they are at high risk of a new cancer
developing in the other breast. This represents about 10 percent of all
women diagnosed with breast cancer. Women without these indications are
very unlikely to develop a second cancer in the healthy breast,
according to the researchers.

Candidates for Lumpectomy

The
study found that among women who had a double mastectomy, nearly 70
percent did not have either a family history or positive genetic test.
Many of these women were candidates for breast-conserving lumpectomy.

“For
women who do not have a strong family history or a genetic finding, we
would argue it’s probably not appropriate to get the unaffected breast
removed,” said Hawley, in the press statement.

A double mastectomy
may result in more complications and a more difficult recovery. In
addition, most women went on to have breast reconstruction as well, and
may also need chemotherapy or radiation therapy after their surgery,
which the researchers said could further delay their recovery.

More Education Urged

The
researchers suggest there is a need for more education among women
about the risks and benefits of contralateral prophylactic mastectomy.
Surgeons should also be aware that patients’ treatment decisions are
affected by their worry about recurrence, said the researchers.

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